Provider Demographics
NPI:1043612401
Name:NEWSON, LAUREN MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
Last Name:NEWSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1561 LONG POND RD
Mailing Address - Street 2:SUITE 408
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4117
Mailing Address - Country:US
Mailing Address - Phone:585-442-4141
Mailing Address - Fax:585-442-6259
Practice Address - Street 1:1561 LONG POND RD
Practice Address - Street 2:SUITE 408
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4117
Practice Address - Country:US
Practice Address - Phone:585-442-4141
Practice Address - Fax:585-442-6259
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF339151-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03990741Medicaid
NYJ400179283/GRPBA0017Medicare PIN
NY03990741Medicaid